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Pre-Operative Geri Assessment: Vicky Tang and Houman Javedan

GeriPal - A Geriatrics and Palliative Medicine Podcast

Release Date: 09/25/2025

GeriPal - A Geriatrics and Palliative Medicine Podcast

Today we interviewed Bob Wachter about his book, “.” You may recall we , and at that time he was on the fence about AI - more promise or more peril for healthcare? As his book’s title suggests, he’s come down firmly on the promise side of the equation. On our podcast we discuss: Why Bob wrote this book, at this time, and concerns about writing a static book about AI and Healthcare, a field that is dynamic and shifting rapidly. He’s right though - we’ve not had a “ChatGPT”-launch type moment recently. Top 5 or so ways in which Bob uses AI for work,...

The Role of Specialty Palliative Care in Cancer Surgery: Rebecca Aslakson & Myrick Shinall

GeriPal - A Geriatrics and Palliative Medicine Podcast

Recent randomized controlled trials have shown that routine perioperative palliative care does not improve outcomes for patients undergoing curative-intent cancer surgery. No, that wasn’t a typo. Regardless of how the data were analyzed, the findings remained consistent: perioperative palliative care DID NOT improve outcomes in the only two randomized controlled trials conducted in this area—the and trials. Null trials like these often receive less attention in academic and clinical settings, but they can be profoundly practice-changing. Consider the . While some have argued it...

The Future of Palliative Care? Community-Based Models with Alan Chiu, Mindy Stewart-Coffee, and Ben Thompson

GeriPal - A Geriatrics and Palliative Medicine Podcast

“I just want to say one word to you. One word. Plastics… There's a great future in plastics.” This iconic line from the movie The Graduate is at the top of my mind when I think about where we are heading in healthcare. I’ve interpreted “plastics” as symbolizing a dystopian, mass-produced future of medicine—where artificiality and inauthenticity dominate in the pursuit of efficiency and profit margins. After listening to today’s podcast on the growth of community-based palliative care, I find my perspective shifting on this quote. Perhaps the advice given for a...

Uncertainty In Medicine: Jonathan Ilgen and Gurpreet Dhaliwal

GeriPal - A Geriatrics and Palliative Medicine Podcast

The only certainty in medicine is uncertainty. It touches every aspect of clinical practice, from diagnosis to treatment to prognosis. Despite this, many clinicians view uncertainty as something to tolerate at best or eliminate at worst. But what if we need to rethink and reframe our relationship with uncertainty in medicine? In this episode, we sit down with Jonathan Ilgen and Gurpreet Dhaliwal, co-authors of the New England Journal of Medicine article, “.” Together, we explore the nature of uncertainty in clinical practice, its effects on trainees and seasoned clinicians, and strategies...

Why We Need QI Collaboratives: Guests Steve Pantilat, David Currow, and Arif Kamal

GeriPal - A Geriatrics and Palliative Medicine Podcast

In a recent episode of the GeriPal podcast, we explored —and, if so, how to save it—with guests Ira Byock, Kristi Newport, and Brynn Bowman. Today, we shift focus to one actionable way to improve palliative care: through quality improvement (QI) collaboratives, registries, and benchmarking. To guide this discussion, we’ve invited three leading experts in the field—Drs. Steve Pantilat, David Currow, and Arif Kamal—who bring invaluable experience as pioneers in developing QI collaboratives and registries. Together, they authored a recent paper in JPSM titled “,” which...

Is Attending to Clinician Distress Our Job? Sara Johnson, Yael Schenker, & Anne Kelly

GeriPal - A Geriatrics and Palliative Medicine Podcast

Have you had one of those consults in which you’re thinking, huh, sounds like the patient’s goals are clear, it’s really that the clinician consulting us disagrees with those goals? To what extent is it our job as consultants to navigate, manage, or attend to clinician distress? What happens when that clinician distress leads eventually to conflict between the consulting clinician and the palliative care team? Today our guests Sara Johnson, Yael Schenker, & Anne Kelly discuss these issues, including: A recent paper first authored by Yael asking if attending to clinician...

Rehab and Death in Skilled Nursing Facilities: Sarguni Singh, Christian Furman, and Lynn Flint

GeriPal - A Geriatrics and Palliative Medicine Podcast

In this week's podcast, we sit down with Drs. Sarguni Singh, Christian Furman, and Lynn Flint, three authors of the recent The authors dive into the challenges facing seriously ill older adults discharged to Skilled Nursing Facilities (SNFs), where fragmented care transitions, misaligned Medicare policies, and inadequate access to palliative care often result in burdensome hospitalizations and goal-discordant care. The discussion highlights key barriers in Medicare’s SNF and hospice benefits, including the inability to access concurrent hospice and SNF care, and explores...

Inflammaging: Brian Andonian, Sara LaHue, Joe Hippensteel

GeriPal - A Geriatrics and Palliative Medicine Podcast

Six years ago we had John Newman on GeriPal to talk about (Song choice Who Wants to Live Forever by Queen, perfect selection). John explained the basics of geroscience, what is it, what are the key theories in geroscience, what is senescence, why people who provide clinical care for older adults should care about geroscience, and potential therapeutics like metformin and rapamycin. Today we bring on three rising stars in Geroscience, Brian Andonian, Sara LaHue, Joe Hippensteel, to talk about one of the key pillars of Geroscience: inflammaging. We use this terrific paper they...

The Chaplain and the Doctor: A Podcast with Betty Clark and Jessica Zitter

GeriPal - A Geriatrics and Palliative Medicine Podcast

In this week’s episode, we delve into the powerful documentary with two extraordinary guests: Betty Clark, the chaplain at the heart of the film, and Dr. Jessica Zitter, the physician and filmmaker who brought this story to the screen. The film provides a deeply moving look into the ways personal stories and biases shape our interactions in healthcare. Through our conversation with Betty and Jessica, I gained a valuable insight: the narratives we carry within ourselves—whether conscious or unconscious—act as invisible forces that influence how we engage with patients and...

A Strategic Path Forward for Hospice & Palliative Care: Ira Byock, Kristi Newport, Brynn Bowman

GeriPal - A Geriatrics and Palliative Medicine Podcast

In June of 2025, hospice and palliative care pioneer Ira Byock . In a nutshell, he expressed concerns that the quality of hospice care in the United States has become highly variable, with disturbing frequency of unethical practices and avaricious owners. He also raised concern that the rapid increase in palliative care program growth during the first two decades of this century has stalled, leaving us with understaffed programs that are often inadequately trained. Along with Ira, we’ve invited Kristi Newport, a palliative care doctor and Chief Medical Officer of the , and Brynn...

More Episodes

We love getting requests from listeners for podcast topics. This request came from geriatricians we met at the annual American Geriatrics Society meeting in Chicago. They wanted to know more about what a geriatrician should do in a pre-operative risk assessment. So we invited Vicky Tang and Houman Javedan, two geriatricians and leaders in the pre-operative assessment and prehab space, to talk with us.

As is our style, we backed up to some bigger questions, including:

-Why do patients need a geriatric assessment pre-operatively?-Why are our surgical colleagues asking us? Is it due to liability concerns?
-Why do we do them? Recognizing we may have different motivations than our consultants (hint: stealth geriatrics)
-How does the comprehensive geriatric assessment fit int? Do the 4Ms fit into pre-operative assessment if at all? (an entertaining disagreement ensued)
-Must a geriatrician do this?
-What is the Geriatric Surgery Verification Program?
-What’s the most important part of

Many links from our guests below.

And please forgive my Spanish on the song, I tried! Thanks to sons Kai and Renn on Ukulele and Bass for making it sound better.

-Alex

From Vicky:

Systematic review of Prehab https://pubmed.ncbi.nlm.nih.gov/39655991/
Geriatric Surgery Verification Program https://www.facs.org/quality-programs/accreditation-and-verification/geriatric-surgery-verification/
shared decision making in surgical patients https://pubmed.ncbi.nlm.nih.gov/40551447/

From Houman:

Geriatric Surgical Co-management Evidence

1. Trauma survival with geriatric assessment 2022- https://pubmed.ncbi.nlm.nih.gov/36102764/
2. Hip fracture survival benefit meta-analysis 2014- https://pubmed.ncbi.nlm.nih.gov/23912859/
3. Elective abdominal surgery benefits POSH program 2018- https://pubmed.ncbi.nlm.nih.gov/29299599/
4. POSH Program for Spine 2021- https://pubmed.ncbi.nlm.nih.gov/33382460/
5. Elective orthopedic joints ED readmission decreases 2024 - https://pubmed.ncbi.nlm.nih.gov/39715294/
6. The need for geriatricians, tools and education models (aka Ms) are not enough - https://pubmed.ncbi.nlm.nih.gov/30916758/

Sub Topics

7. Utility of minicog and where our improved local mortality of 18% and delirium of 11% reported - https://pubmed.ncbi.nlm.nih.gov/27147687/

8. Geriatrician performed CGA-FI best at predicting mortality in rib fractures 2025 - https://pubmed.ncbi.nlm.nih.gov/39800638/

9. Geriatrician performed CGA-FI predicting mortality better than age in hip fractures 2024- https://pubmed.ncbi.nlm.nih.gov/39007664/

10. Multidomain frailty assessment and surgery showing severely frail patients at risk of mortality even with low risk procedures (eg. Cystoscopy) - https://pubmed.ncbi.nlm.nih.gov/31721994/

11. Different outcomes for hip fracture surgery in the severely frail - https://pubmed.ncbi.nlm.nih.gov/38892908/

12. Complexity of aging physiology- example of prostaglandin based free water excretion in collecting duct of aging kidney first paragraph on page 360- https://pubmed.ncbi.nlm.nih.gov/36948780/

TOPICS